A tracheotomy is a surgical procedure in which a cut or opening is made in the trachea. The term tracheostomy is sometimes used interchangeably with tracheotomy, although the word “tracheostomy” generally refers to the opening itself while the word “tracheotomy” generally refers to the actual operation. A tube, cannula, stoma stent or other device may be inserted into the tracheostomy to hold it open, bypass an obstruction and/or allow air to get to the lungs.
Typically, an emergency tracheotomy is performed only as a last-resort procedure, when the patient's trachea is obstructed and the situation is life-threatening. Such an emergency situation may occur, for example, where the trachea is blocked by swelling that results from anaphylactic shock, or from a severe trauma to the neck, nose or mouth, or where the trachea is blocked by the presence of a foreign object in the larynx. A cut is made with a scalpel or any available tool in a thin part of the larynx called the cricothyroid membrane. An endotracheal tube is then inserted through the cut in the cricothyroid membrane, through which the patient can breathe. As popularized on television and in the movies, in dire situations where no other tools are available, a ballpoint pen casing with the ink cartridge removed may be used to penetrate the cricothyroid membrane or other portion of the trachea, and is then left in place to allow the patient to breathe through it. An emergency tracheotomy also is called a cricothyroidotomy. In this document, the terms “tracheotomy” and “cricothyroidotomy” are used synonymously and interchangeably.
Emergency tracheotomies or cricothyroidotomies are generally disfavored, in part due to the potential for error. The person performing the procedure may have minimal or no medical training, and as a result may cause more injury attempting the procedure than would have resulted without it. One potential for error lies in the proper placement of the endotracheal tube, which should be at the cricothyroid membrane and not through the cartilage of the trachea. Another potential for error lies in the inadvertent puncture of the opposite wall of the trachea during performance of the tracheotomy. In addition, placement of a tube, cannula, stoma stent, or similar device in the resultant tracheostomy to prevent it from closing may be difficult, particularly if the person performing the procedure has minimal or no medical training.
Referring to FIG. 1, the trachea 2 of a patient includes a number of tracheal cartilage rings 4. Adjacent tracheal cartilage rings 4 are spaced apart from one another and connected by membranes 6. The larynx 8 is located at the superior end of the trachea 2. The thyroid cartilage 10 is positioned adjacent to and anterior to part of the larynx 8. The thyroid cartilage 10 is usually prominent in males, where a portion of it protrudes as the Adam's apple. The cricoid cartilage 12 is located superior to the uppermost tracheal cartilage ring 4, spaced apart from that ring 4 and connected to it by a membrane 6. An indentation 14 is present on the anterior surface of the cricoid cartilage 12, inferior to the thyroid cartilage 10. The cricothyroid membrane 16 is positioned in that indentation 14. Although different patients may exhibit variations, the anatomy shown in FIG. 1 is standard.
The use of the same reference symbols in different figures indicates similar or identical items.